SUDDEN DEATH of Young Athletes Can Be Prevented - hypertrophic cardiomyopathy - Statistical Data Included

USA Today (Society for the Advancement of Education), March, 2001 by Robert J. Siegel, Bruce J. Kimura

KEVIN RICHARDS, an Evanston (Ill.) High School track runner, died in February, 2000, after finishing second in a race.

* Tim Collins, Lafayette High School, Lexington, Ky., died in November, 1999, during basketball practice.

* Steven "Scotty" Lang, a Fountain Valley (Calif.) High School football player, died in November, 1999, during practice drills.

* John Stewart, a University of Kentucky basketball recruit, died in March, 1999, during a regional championship high school basketball game in Columbus, Ind.

* Gerald Grainger, Zion-Benton Township High School, Chicago, Ill., died in September, 1997, following a long-distance run in gym class.

The list is lengthy. These high school athletes are sad proof that heart disease--the nation's number-one killer--takes youngsters as well as adults. Sudden death on the playing field is a high-visibility tragedy that claims the lives of seemingly healthy young people, athletes and nonathletes alike.

Many of these sudden deaths were caused by an asymptomatic heart condition for which there was no obvious warning. One of the so-called "silent" conditions is hypertrophic cardiomyopathy (HCM), a disorder in which the heart muscle unexplainably becomes excessively thick. This condition can be present with--or without--symptoms such as chest pain, shortness of breath, or fainting. Unfortunately for victims, the first symptom can be death itself, with the condition not diagnosed until an autopsy is performed.

A thickened heart muscle (in HCM, predominantly of the left ventricle) is more sensitive to a lack of blood supply and more irritable than a normal heart. As a consequence of this irritability, the heart is more prone to dangerous forms of heart irregularities, such as ventricular tachycardia or ventricular fibrillation, which can render heart contractions fatally ineffective, unless treated.

HCM is thought to cause one out of every three cases of sudden death among athletes, and approximately one person in 500 births is affected by HCM. The disease is hereditary in more than half the cases.

Athletes with HCM are at greater risk because the two factors that are thought to trigger a catastrophic event in a hypertrophied heart muscle that characterizes this condition are dehydration and increased adrenaline. Both are common situations during physical exertion.

The good news is that, if detected, even "silent" heart conditions such as HCM can be treated. However, physicians cannot treat what is not diagnosed, and, in the case of young athletes, the longtime standard of pre-sports physical exams may not go far enough to find defects and avert tragedy. In the majority of "regular" exams, the physician listens to the heart's sounds with a stethoscope. This method of examination, called auscultation, has remained unchanged since the invention of the stethoscope in 1819.

Until recently, the technology that allows doctors actually to see the function and structural health of the heart--ultrasound--was not well-suited (by virtue of cost, immobility of equipment, and complexity of a full-scale examination) for screening groups of people, many of whom show no symptoms of a potential problem. Today, there is an option of a different approach, as new forms of ultrasound technology make broader application of cardiac screening practical and feasible from medical, economic, and logistical perspectives.

When ultrasound is used to examine the heart, it is known as echocardiography or an "echo." In this painless, noninvasive diagnostic test, low-power, high-frequency sound waves bounce over the heart and produce a picture that allows a trained health care professional to assess the thickness, size, and function of the organ. The difference between using a stethoscope and an echo to examine the function of the heart is like night and day. With one, you can only listen; with the other, you can actually look inside.

This is not to say that the use of a stethoscope is not important and valuable during physical exams. In a number of cases, cardiac ultrasound screening could be an effective adjunct to "regular" exams to reduce the risk of complications from undiagnosed cardiovascular disease, up to and including sudden death.

In particular, hand-carried devices that offer a lower-cost way to bring exams to groups of people are being used to perform "limited" echoes--a type of exam that allows physicians to look quickly at the heart, but is not as costly as a "full" checkup that doctors would perform on a patient suspected of having a problem, or in a case in which a limited echo showed something that warrants examining further.

A study by Barry J. Maron of the Minneapolis (Minn.) Heart Institute Foundation and colleagues reviewed 158 fatal incidents among athletes and found that sudden death is most common among basketball and football players, the sports with the highest participation levels in the U.S. Together, these two groups accounted for 68% of sudden deaths. The median age of death was 17 years old, and the prevalence was disproportionately higher among males, as well as African-American athletes. Ninety percent collapsed during or immediately after a training session, with 63% of deaths occurring between 3 p.m. and 9 p.m. (the time period when most games and practices occur).